{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T23:18:20Z","timestamp":1787008700259,"version":"build-2736575974"},"reference-count":19,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2022,8,25]],"date-time":"2022-08-25T00:00:00Z","timestamp":1661385600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,9,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Immune checkpoint inhibitors (ICIs) have markedly improved outcome in various types of cancer. ICI-associated myocarditis is one of the most severe immune-related adverse events. In particular, high concentrations of cardiac troponin T (cTnT) are associated with a high risk of death and early detection and vigorous therapy with high-dose steroids may improve survival. However, chronic skeletal muscle disorders have been suggested as a non-cardiac source of elevated high-sensitivity cardiac troponin T (hs-cTnT) concentrations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case summary<\/jats:title>\n                    <jats:p>Here, we present the case of a 72-year-old patient with metastatic melanoma treated with nivolumab and ipilimumab, who developed symptomatic myositis [creatine kinase (CK) max. 3113\u2005U\/L]. Due to substantially elevated concentrations of hs-cTnT (max. 1128\u2005ng\/L, normal &amp;lt;14\u2005ng\/L, Elecsys), the patient was referred to the cardio-oncology unit for evaluation of concomitant myocarditis. The patient did not report any cardiac symptoms and there were no clinical signs of congestion or rhythm abnormalities. Concentrations of NT-proBNP were within the normal range. Echocardiography showed normal cardiac dimensions and normal systolic and diastolic function. Cardiac magnetic resonance imaging confirmed these findings and also showed no evidence of acute or post-inflammatory myocardial tissue changes. Absence of relevant cardiomyocyte injury was supported by determination of normal levels of cardiac troponin I concentrations and made endomyocardial biopsy in this severely ill patient unnecessary.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Our observation documents ICI-induced myositis as an alternative non-cardiac cause of hs-cTnT elevation. A global cardiologic approach employing clinical and cardiac magnetic resonance imaging data as well as NT-proBNP and cardiac troponin I helps to identify false positive hs-TnT elevation under ICI therapy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytac353","type":"journal-article","created":{"date-parts":[[2022,8,25]],"date-time":"2022-08-25T14:38:23Z","timestamp":1661438303000},"source":"Crossref","is-referenced-by-count":9,"title":["Case report of elevation of high-sensitivity cardiac troponin T in the absence of cardiac involvement in immune checkpoint inhibitor-associated myositis"],"prefix":"10.1093","volume":"6","author":[{"given":"Francisco Javier","family":"Ruperti-Repilado","sequence":"first","affiliation":[{"name":"Department Circulation, Thorax, Transplantation, Clinic of Cardiology, University Hospital Basel , Petersgraben 4, 4031 Basel , Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan Gerrit","family":"van der Stouwe","sequence":"additional","affiliation":[{"name":"Department of Acute Medicine, Clinic of Internal Medicine, University Hospital Basel , Petersgraben 4, 4031 Basel , Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip","family":"Haaf","sequence":"additional","affiliation":[{"name":"Department Circulation, Thorax, Transplantation, Clinic of Cardiology, University Hospital Basel , Petersgraben 4, 4031 Basel , Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Mueller","sequence":"additional","affiliation":[{"name":"Department Circulation, Thorax, Transplantation, Clinic of Cardiology, University Hospital Basel , Petersgraben 4, 4031 Basel , Switzerland"},{"name":"Cardiovascular Research Institute Basel (CRIB), University Hospital Basel , Spitalstrasse 2, 4056 Basel , Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heinz","family":"L\u00e4ubli","sequence":"additional","affiliation":[{"name":"Department of Theragnostic, Division of Medical Oncology, University Hospital Basel , Petersgraben 4, 4031 Basel , Switzerland"},{"name":"Department of Biomedicine, University Hospital and University of Basel , 4031 Basel , Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Otmar","family":"Pfister","sequence":"additional","affiliation":[{"name":"Department Circulation, Thorax, Transplantation, Clinic of Cardiology, University Hospital Basel , Petersgraben 4, 4031 Basel , Switzerland"},{"name":"Department of Biomedicine, University Hospital and University of Basel , 4031 Basel , Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sacha I","family":"Rothschild","sequence":"additional","affiliation":[{"name":"Department of Theragnostic, Division of Medical Oncology, University Hospital Basel , Petersgraben 4, 4031 Basel , Switzerland"},{"name":"Department of Biomedicine, University Hospital and University of Basel , 4031 Basel , Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriela M","family":"Kuster","sequence":"additional","affiliation":[{"name":"Department Circulation, Thorax, Transplantation, Clinic of Cardiology, University Hospital Basel , Petersgraben 4, 4031 Basel , Switzerland"},{"name":"Department of Biomedicine, University Hospital and University of Basel , 4031 Basel , Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,8,25]]},"reference":[{"key":"2024051617561025600_ytac353-B1","doi-asserted-by":"crossref","first-page":"51","DOI":"10.3390\/antib8040051","article-title":"Therapeutic monoclonal antibodies targeting immune checkpoints for the treatment of solid tumors","volume":"8","author":"Gravbrot","year":"2019","journal-title":"Antibodies (Basel)"},{"key":"2024051617561025600_ytac353-B2","doi-asserted-by":"crossref","first-page":"e447","DOI":"10.1016\/S1470-2045(18)30457-1","article-title":"Immune checkpoint inhibitors and cardiovascular toxicity","volume":"19","author":"Lyon","year":"2018","journal-title":"Lancet Oncol"},{"key":"2024051617561025600_ytac353-B3","doi-asserted-by":"crossref","first-page":"1755","DOI":"10.1016\/j.jacc.2018.02.037","article-title":"Myocarditis in patients treated with immune checkpoint inhibitors","volume":"71","author":"Mahmood","year":"2018","journal-title":"J Am Coll Cardiol"},{"key":"2024051617561025600_ytac353-B4","doi-asserted-by":"crossref","first-page":"1059","DOI":"10.1016\/j.cjca.2018.03.012","article-title":"Cardiac complications associated with checkpoint inhibition: a systematic review of the literature in an important emerging area","volume":"34","author":"Mir","year":"2018","journal-title":"Can J Cardiol"},{"key":"2024051617561025600_ytac353-B5","doi-asserted-by":"crossref","first-page":"933","DOI":"10.1016\/S0140-6736(18)30533-6","article-title":"Increased reporting of fatal immune checkpoint inhibitor-associated myocarditis","volume":"391","author":"Moslehi","year":"2018","journal-title":"Lancet"},{"key":"2024051617561025600_ytac353-B6","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1161\/CIRCULATIONAHA.118.035898","article-title":"Immune checkpoint inhibitor\u2013associated myositis: expanding the spectrum of cardiac complications of the immunotherapy revolution","volume":"138","author":"Anquetil","year":"2018","journal-title":"Circulation"},{"key":"2024051617561025600_ytac353-B7","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1093\/eurheartj\/ehv320","article-title":"2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent st-segment elevation: task force for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation of the European society of cardiology (ESC)","volume":"37","author":"Roffi","year":"2016","journal-title":"Eur Heart J"},{"key":"2024051617561025600_ytac353-B8","doi-asserted-by":"crossref","first-page":"1540","DOI":"10.1016\/j.jacc.2018.01.070","article-title":"Elevated cardiac troponin T in patients with skeletal myopathies","volume":"71","author":"Schmid","year":"2018","journal-title":"J Am Coll Cardiol"},{"key":"2024051617561025600_ytac353-B9","doi-asserted-by":"crossref","first-page":"2936","DOI":"10.1016\/j.jacc.2018.09.050","article-title":"Rhabdomyolysis: a noncardiac source of increased circulating concentrations of cardiac troponin T?","volume":"72","author":"du Fay de Lavallaz","year":"2018","journal-title":"J Am Coll Cardiol"},{"key":"2024051617561025600_ytac353-B10","doi-asserted-by":"crossref","first-page":"1749","DOI":"10.1056\/NEJMoa1609214","article-title":"Fulminant myocarditis with combination immune checkpoint blockade","volume":"375","author":"Johnson","year":"2016","journal-title":"N Engl J Med"},{"key":"2024051617561025600_ytac353-B11","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1186\/s40425-015-0057-1","article-title":"Acute heart failure due to autoimmune myocarditis under pembrolizumab treatment for metastatic melanoma","volume":"3","author":"L\u00e4ubli","year":"2015","journal-title":"J Immunother Cancer"},{"key":"2024051617561025600_ytac353-B12","doi-asserted-by":"crossref","first-page":"1765","DOI":"10.1016\/j.jacc.2018.02.038","article-title":"Cardiac toxicity in patients treated with immune checkpoint inhibitors: it is now time for cardio-immuno-oncology","volume":"71","author":"Tocchetti","year":"2018","journal-title":"J Am Coll Cardiol"},{"key":"2024051617561025600_ytac353-B13","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1007\/s11912-018-0690-1","article-title":"Cardiotoxicity of immunotherapy: incidence, diagnosis, and management","volume":"20","author":"Asnani","year":"2018","journal-title":"Curr Oncol Rep"},{"key":"2024051617561025600_ytac353-B14","doi-asserted-by":"crossref","first-page":"2711","DOI":"10.3899\/jrheum.090562","article-title":"Serum cardiac troponin T, but not troponin I, is elevated in idiopathic inflammatory myopathies","volume":"36","author":"Aggarwal","year":"2009","journal-title":"J Rheumatol"},{"key":"2024051617561025600_ytac353-B15","doi-asserted-by":"crossref","first-page":"2636","DOI":"10.1093\/eurheartj\/eht210","article-title":"Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the European society of cardiology working group on myocardial and pericardial diseases","volume":"34","author":"Caforio","year":"2013","journal-title":"Eur Heart J"},{"key":"2024051617561025600_ytac353-B16","doi-asserted-by":"crossref","first-page":"1733","DOI":"10.1093\/eurheartj\/ehaa051","article-title":"Cardiovascular magnetic resonance in immune checkpoint inhibitor-associated myocarditis","volume":"41","author":"Zhang","year":"2020","journal-title":"Eur Heart J"},{"key":"2024051617561025600_ytac353-B17","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1186\/s40425-017-0296-4","article-title":"Smoldering myocarditis following immune checkpoint blockade","volume":"5","author":"Norwood","year":"2017","journal-title":"J Immunother Cancer"},{"key":"2024051617561025600_ytac353-B18","doi-asserted-by":"crossref","first-page":"2303","DOI":"10.1093\/eurheartj\/ehu188","article-title":"Direct comparison of high-sensitivity-cardiac troponin i vs. T for the early diagnosis of acutemyocardial infarction","volume":"35","author":"Rubini Gimenez","year":"2014","journal-title":"Eur Heart J"},{"key":"2024051617561025600_ytac353-B19","doi-asserted-by":"crossref","first-page":"e003594","DOI":"10.1136\/jitc-2021-003594","article-title":"68Ga-DOTATOC PET\/CT to detect immune checkpoint inhibitor-related myocarditis","volume":"9","author":"Boughdad","year":"2021","journal-title":"J Immunother Cancer"}],"container-title":["European Heart Journal - Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ehjcr\/advance-article-pdf\/doi\/10.1093\/ehjcr\/ytac353\/45536824\/ytac353.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcr\/article-pdf\/6\/9\/ytac353\/57707954\/ytac353.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcr\/article-pdf\/6\/9\/ytac353\/57707954\/ytac353.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,16]],"date-time":"2024-05-16T14:01:24Z","timestamp":1715868084000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjcr\/article\/doi\/10.1093\/ehjcr\/ytac353\/6675725"}},"subtitle":[],"editor":[{"given":"Sameh","family":"Shaheen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]},{"given":"Albert","family":"Galyavich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]},{"given":"Parag","family":"Bawaskar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]},{"given":"Alexander","family":"Tindale","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]},{"given":"Katharine","family":"Kott","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2022,8,25]]},"references-count":19,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2022,9,5]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjcr\/ytac353","relation":{},"ISSN":["2514-2119"],"issn-type":[{"value":"2514-2119","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2022,9,1]]},"published":{"date-parts":[[2022,8,25]]},"article-number":"ytac353"}}